1. Truven Health MarketScan Database for Research
Dana A. Telem MD MPH
Associate Chair for Clinical Affairs
Associate Professor of Surgery
Director, Comprehensive Hernia Program
University of Michigan

2. Disclosures
None
DEPARTMENT of SURGERY

3. Data needed to investigate impact on:
Origins of MarketScan
Late 1980s  managed care
Data needed to investigate impact on:
Cost
Quality
Health outcomes
Cost Effectiveness
MarketScan created
Department of Surgery

4. MarketScan Datasets
Service level claims for inpatient and outpatient services AND outpatient prescription drugs
Unique enrollee identifier for each individual
Additional data enhancements:
Comparison of diagnosis and procedure codes
Addition of major diagnostic categories and diagnosis related groups to claims
Identifying type of plan (e.g., HMP, PPO, POS)
Department of Surgery

5. Largest collection of de-identified U.S. patient data
MarketScan Database
Largest collection of de-identified U.S. patient data
More than 32 billion service records
~240 million covered lives
Over 260 contributing employers
40 contributing health plans
Representation from 350 unique carriers
No Medicaid or Workers Comp
Department of Surgery

6. MarketScan Data: Integrated at Patient Level
Department of Surgery

7. Commercial Dataset: Sample Data Elements
Department of Surgery

8. Clinical Case Studies
Question: Impact of a novel hernia technique on outcomes and healthcare expenditures?
Years 2009 – 2015
> 2 million enrollees
Age 18-65
Department of Surgery

9. Incidence and Outcomes
Adjusted incidence rate per 100,000 persons of component separation doubled from 0.21 to .43(p=.015).
For reference, open hernia repair significantly decreased from 3.4 to 2.1(p < .001) and remained unchanged for minimally invasive hernia (1.1 to 1.3, p=0.9).
CS was significantly associated with increased 30-day readmissions (OR 1.49[ ], p < .001) and 30-day adverse outcomes (OR 1.28[1.05, 1.55],p=.014) as compared to hernia repair without CS.
Department of Surgery

10. Healthcare Expenditures
In 2015, CS accounted for 12.7%($31.6M) of total inpatient payments for hernia repair compared to 4.3%($13.6M) in 2009.
Department of Surgery

11. Background
Question: Policy evaluation of elective EHB to cover obesity treatment.
Retrospective, longitudinal study using MarketScan data from 50 states (n=113,585).
Changes in bariatric surgery utilization for patients in states that enacted a EHB to cover bariatric surgery (n=23 states, 55,432 patients) and states that did not (n=27 states, n= 58,115 patients).
Policy impact was evaluated by a multiple group interrupted time series analysis.
Department of Surgery

12. Outcomes
Risk and seasonally adjusted mean utilization per 100,000 population pre and post-policy implementation was 18.1±2.6 vs. 21.3±2.9 (p<0.001,17.6%) in states with the EHB and 14.6±2.0 vs. 17.4±3.0 (p=0.02,19.0%) in states without the EHB.
Increased utilization was independent of the EHB. There were no differences in the adjusted quarterly utilization rates above the temporal trend between states that did and did not enact the EHB (slope -.12[-0.4,0.17],p=0.41).
Department of Surgery

13. Outcomes
Department of Surgery

14. Possible or Not Possible
Research Question:
Does use of enoxapatin prophylaxis in the hospital reduce the risk of VTE after surgery?
Answer: Not Possible
Why: No inpatient drug data, only outpatient.
Department of Surgery

15. Possible or Not Possible
Research Question:
Does early childhood cancers (before age 10) lead to premature coronary events?
Answer: Not Possible
Why: Length time on an insurance product, age
Department of Surgery

16. Possible or Not Possible
Research Question:
Do patients in HMO type insurance have fewer ED visits than patients with a fee-for-service type insurance?
Answer: Possible!
Why: Can parse out insurance products
Department of Surgery

17. Possible or Not Possible
Research Question:
Do patients who undergo laparoscopic colon resection have shorter lengths of stay than those who undergo open colectomy?
Answer: Possible!
Why: Can parse out outcomes.
Department of Surgery

18. Possible or Not Possible
Research Question:
Do older adults with urinary incontinence had more ED visits than those without incontinence?
Answer: Not possible
Why: Medicare data not available
Department of Surgery

19. Truven Health MarketScan® Research Databases For Health Services Research – A Compelling Case Study Mr. Neil Kamdar, Lead Statistician, Data & Methods Hub, Institute for Health Care Policy & Innovation Ms.Tanima Banerjee, Senior Statistician, Data & Methods Hub, Institute for Health Care Policy & Innovation Date: 3/20/2018 Ann Arbor mi
D&MH, IHPI

20. Truven Health MarketScan® Database for Research
Outline
Part 1:
Truven Health MarketScan® Database for Research
Part 2:
Overview of the Truven Health MarketScan® Research Databases
D&MH, IHPI

21. Health Insurance Coverage of the Total US Population CY 2016
In response to rising costs, fundamental changes occurred in the US healthcare system in the late 1980s as healthcare delivery shifted toward managed care arrangements. At the time, data sources to support these analyses were inadequate. Importantly, there was a lack of reliable healthcare data on privately insured patients and their families. This group continues to comprise the largest segment of US healthcare users—nearly half of the total US population (see Figure 1). 33% represents Medicare & Medicaid population. prevalence, incidence and costs of specific diseases, as well as the effectiveness and cost implications of interventions, clinical guidelines and quality improvement initiatives. Providers, healthcare facilities and life sciences companies were interested in the cost-effectiveness of different therapies in real-world clinical care.
D&MH, IHPI
Source: Kaiser Family Foundation

22. Largest proprietary database
Reliable Data Source for Health Services Research
Health Insurance Portability and Accountability Act of 1996
The New England Journal of Medicine in 1990 (J.B. Hillman et al.).
20 billion service records
30 years of history in health service research
1988-present
Largest proprietary database
HIPAA complaint
1,100 peer-reviewed
MarketScan-based research has made a substantial contribution to the body of literature used to formulate policy decisions and improve healthcare for Americans.
D&MH, IHPI
SOURCE: Truven Health MarketScan® Research Databases.

23. Reliable Data Source for Health Services Research
Health Service Research
Clinical research
Adverse event rate
Treatment outcomes
Population studies
Health and workforce productivity
Economic burden of illness & costs of health risks
Dental research
Researchers has been using MarketScan data to investigate different fields of research under the umbrella of health service research. One unique characteristic of MarketScan data is that we can link dental claims of the member to their medical claims. Truven Health researchers Misra et al examined the relationship between periodontal disease, statin (HMG-CoA) use and cardiovascular disease using the MarketScan Dental Database. Using a matched control group, patients identified as having periodontal disease by ICD-9 code or related dental procedures were divided into two cohorts: those treated with statins and those not treated with statins. The patients were followed for 12 months to observe evidence of cardiovascular events. There were no cardiovascular events in 99 percent of patients with periodontal disease. Twenty-five percent of patients with the disease were on statin medications
D&MH, IHPI
SOURCE: Truven Health MarketScan® Research Databases.

24. MarketScan Attributes
Administrative health claims person-level data from approximately 350 payers, 100 different insurance companies, Blue Cross Blue Shield plans, and third party administrators
More than 32 billion service records available with ~240 M covered lives
Updates delivered annually, when 100% claims have been paid
Integrated enrollment, medical and pharmacy data
Insured employees & their dependents for active employees, early retirees, Consolidated Omnibus Budget Reconciliation Act (COBRA) continues and Medicare-eligible retirees with employer-provided Medicare Supplemental plans.
De-identified or blinded data to protect patient privacy, yet supports patient-linked longitudinal analysis
ICD-10 compliant
collecting data from employers, health plans and state Medicaid agencies who are our customers and have agreed to be data contributors to the MarketScan data warehouse. The MarketScan databases reflect the healthcare experience of employees and dependents covered by the health benefit programs of large employers. No Medicaid or Workers Compensation data are included.
D&MH, IHPI
SOURCE: Truven Health MarketScan® Research Databases.

25. Truven MarketScan® -Population
8 years of data
133.8 M (commercial claims)
9.9 M (Medicare Supplement)
Principal diag/proc code. Rest is assigned chronologically based on service dates. The Inpatient Admissions Table differs from UB04 discharge data in that Truven Health combines the facility charges with the physician services associated with an inpatient admission. UB04 revenue codes are retained in the MarketScan data when available
D&MH, IHPI

26. Demographic Distribution of the MarketScan® Population
53.1 M Members in CY 2009
Principal diag/proc code. Rest is assigned chronologically based on service dates. The Inpatient Admissions Table differs from UB04 discharge data in that Truven Health combines the facility charges with the physician services associated with an inpatient admission. UB04 revenue codes are retained in the MarketScan data when available
D&MH, IHPI

27. Demographic Distribution of the MarketScan® Population
Age distribution in commercial claims
Principal diag/proc code. Rest is assigned chronologically based on service dates. The Inpatient Admissions Table differs from UB04 discharge data in that Truven Health combines the facility charges with the physician services associated with an inpatient admission. UB04 revenue codes are retained in the MarketScan data when available
D&MH, IHPI

28. Distribution of Insurance types
Demographic Distribution of the MarketScan® Population
Distribution of Insurance types
type of plan, such as health maintenance organization (HMO), preferred provider organization (PPO), and point-of-service (POS) or comprehensive plans. Exclusive Provider Organization (EPO) Plans, high-deductible health plan (HDHP) 
D&MH, IHPI

29. Demographic Distribution of the MarketScan® Population
CY 2009 (N=53.1 M)
Principal diag/proc code. Rest is assigned chronologically based on service dates. The Inpatient Admissions Table differs from UB04 discharge data in that Truven Health combines the facility charges with the physician services associated with an inpatient admission. UB04 revenue codes are retained in the MarketScan data when available
D&MH, IHPI

30. Truven Marketscan Data Tables
Enrollment Tables (A,T)
Medical/
Surgical Tables (I,S,F,O)
Pharmacy Table (D)
Table
Descriptions
Table Name
Commercial Claims /Medicare Supplement
Commercial
Medicare A
Annual Enrollment Summary File
ccaea
mdcra D
Outpatient Prescription Drug File
ccaed
mdcrd F
Facility Header File
ccaef
mdcrf I
Inpatient Admissions* File
ccaei
mdcri O
Outpatient Services File
ccaeo
mdcro P
Populations File (Aggregated)
ccaep
mdcrp S
Inpatient Services* File
ccaes
mdcrs T
Enrollment Detail File
ccaet
mdcrt R
RED BOOK(tm) prescription drug information by National Drug Code (NDCNUM)
The Inpatient Admissions Table contains records that summarize information about a hospital admission. associated with an admission (e.g., hospital claims, physician claims, surgeon claims, and claims from independent laboratories). Truven Health uses the Centers for Medicare& Medicaid Services (CMS) DRG Grouper to assign an MDC and DRG to the admission record.
D&MH, IHPI
Note: *a room and board claim must be present

31. Overview of the Data Tables
Snapshot of the Annual Member file
DTSTART AND DTEND ARE NOT AVAILABLE like eligeff & eligend in OPTUMInsight
D&MH, IHPI

32. Overview of the Data Tables Snapshot of the Member Detail file
Snapshot of Annual Member file
DTSTART AND DTEND
D&MH, IHPI

33. Snapshot of the Inpatient Admission (I) Table
1% or less with missing enrollee id in the entire Marketscan population. It is recommended not to use the information with missing ID in the analysis. Principal diag/proc code is available. Rest (DX1 to DX15 / PROC1-15) is assigned chronologically based on service dates. The Inpatient Admissions Table differs from UB04 discharge data in that Truven Health combines the facility charges with the physician services associated with an inpatient admission. UB04 revenue codes are retained in the MarketScan data when available

34. Snapshot of the Inpatient services table
DX1 TO DX4 AND PDX
PPROC & PROC1

35. Snapshot of the Outpatient services table

36. Snapshot of the Outpatient Prescription Drug table

37. Snapshot of the Red Book

38. Snapshot of the Populations File (Aggregated)

39. Snapshot of the Facility Header table
DX1 TO DX9 & PROC1 TO 6.

40. Relationship between Facility Header & outpatient service tables
Facility Header table

41. √ (at least one paid claim)
Comparing Health Services Research Databases
Research Database
Private Database
Data characteristics
CMS Medicare
CMS Medicaid
OptumInsight
Truven Marketscan
Data years
13+ years
(56%)
16+ years
( *)
8 years
( )
Number of Insured lives
51 M
~72 M
77.9 M
~144 M
Cont. enrollment √
COB
Lag time
One year
Varies by States
Half year
Denied claims --
√ (at least one paid claim)
Dental included
D&MH, IHPI

42. Comparing Health Services Research Databases
Private Database
Demographic
characteristics
CMS Medicare
CMS Medicaid
OptumInsight
Truven Marketscan
Date of Birth √
Birth Year
Age
65+ or disabled
0 to 100+
0 to 90 years
Race
√ (SES, DOD view)
x (ZIP view) --
Employment status
SES
√(SES view)
Death information
√ (DOD view)
SES presents in the Medicare or Medicaid [Home Health Outcome and Assessment Information Set (OASIS)]
D&MH, IHPI

43. Comparing Health Services Research Databases
Private Database
Region
CMS Medicare
CMS Medicaid
OptumInsight
Truven Marketscan
Census region --
√ (SES, DOD) √
State
√ (DOD)
County
ZIP code
√ (5 digit)
√ (3 digit )
MSA
HRR
(Geographic Variation Public Use File provides) HRR in Medicare & Medicaid.
D&MH, IHPI

44. Questions? Department of Surgery Neil Kamdar, Lead Statistician
Tanima Banerjee, Senior Statistician
Department of Surgery